Pain physician
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The analysis of epidural procedure utilization has revealed several notable trends over recent years. Utilization increased significantly until 2004, then rose minimally until 2011, followed by gradual declines up to 2019 in the Medicare population. The COVID-19 pandemic led to a marked 19% decline in usage from 2019 to 2020. Additionally, recent studies of interventional pain management techniques showed a 28.9% reduction in use from 2019 to 2022, leading to an average annual decline of 10.9%. ⋯ This two-decade analysis indicates significant shifts in epidural procedure utilization, with steady increases until 2010, followed by a general decline affected by COVID-19 and other contributing factors. An approximate 24% decline in epidural procedure visits for chronic spinal pain management was noted from 2019 to 2022.
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Randomized Controlled Trial Comparative Study
Comparative Study Between the Analgesic Effect of Prednisolone and Pregabalin in Managing Post Dural Puncture Headache After Lower Limb Surgeries.
Post dural puncture headache (PDPH) is a major challenging complication and may be a cause of morbidity after spinal anesthesia. Currently there is no definitive management for PDPH, so the search for effective treatment continues. ⋯ Both oral prednisolone and pregabalin were effective in reducing PDPH severity; oral pregabalin is superior to prednisolone.
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Recent research underscores the potential of intradiscal biologics, such as mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), and alpha-2-macroglobulin, in promoting chondrogenesis within lumbar intervertebral discs as a treatment for discogenic low back pain. Studies indicate significant improvements in pain relief, physical function, and overall quality of life following these interventions. ⋯ This systematic review and single-arm meta-analysis suggest that intradiscal injections of MSCs and PRP may be effective in managing discogenic low back pain, supported by Level III evidence.
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Hip osteoarthritis is a joint disease that causes worsening pain and inhibits activities of daily living. Due to poor pain control and the function of usual clinical treatment, joint infiltration with orthobiologics is a therapeutic alternative. Among these, bone marrow aspirate (BMA) represents a cellular therapy with promising clinical results. ⋯ In this meta-analysis, joint infiltration with BMA or BMC was associated with an improvement in pain and quality of life in patients with hip osteoarthritis. Further randomized studies are needed to improve the quality of evidence.